Sexual abuse. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse or exposure to child pornography.

Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.

Most child abuse is inflicted by someone the child knows and trusts, often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.

A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. In fact, the child may have an apparent fear of parents, adult caregivers or family friends. That's why it's vital to watch for red flags, such as:

Withdrawal from friends or usual activities

Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance

Depression, anxiety or a sudden loss of self-confidence

An apparent lack of supervision

Frequent absences from school or reluctance to ride the school bus

Reluctance to leave school activities, as if he or she doesn't want to go home

Attempts at running away

Rebellious or defiant behavior

Attempts at suicide

Specific signs and symptoms depend on the type of abuse. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

Physical abuse signs and symptoms

Unexplained injuries, such as bruises, fractures or burns

Injuries that don't match the given explanation

Untreated medical or dental problems

Sexual abuse signs and symptoms

Sexual behavior or knowledge that's inappropriate for the child's age

Pregnancy or a sexually transmitted infection

Blood in the child's underwear

Statements that he or she was sexually abused

Trouble walking or sitting

Abuse of other children sexually

Emotional abuse signs and symptoms

Delayed or inappropriate emotional development

Loss of self-confidence or self-esteem

Social withdrawal

Depression

Headaches or stomachaches with no medical cause

Avoidance of certain situations, such as refusing to go to school or ride the bus

Desperately seeks affection

Neglect signs and symptoms

Poor growth or weight gain

Poor hygiene

Lack of clothing or supplies to meet physical needs

Taking food or money without permission

Eating a lot in one sitting or hiding food for later

Poor record of school attendance

Lack of appropriate attention for medical, dental or psychological problems, even though the parents have been notified

Emotional swings that are inappropriate or out of context to the situation

Parental behavior

Appears unable to recognize physical or emotional distress in the child

Denies that any problems exist at home or school, or blames the child for the problems

Consistently blames, belittles or berates the child and describes the child with negative terms, such as "worthless" or "evil"

Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child

Uses harsh physical discipline or asks teachers to do so

Demands an inappropriate level of physical or academic performance

Severely limits the child's contact with others

Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

Although most child health experts condemn the use of violence in any form, some people still use corporal punishment (such as spanking) as a way to discipline their children. Corporal punishment has limited effectiveness in deterring behavior and is associated with aggressive behavior in the child. Any corporal punishment may leave emotional scars.

Parental behaviors that cause pain or physical injury — even when done in the name of discipline — could be child abuse.

When to see a doctor

If you're concerned that your child or another child has been abused, seek help immediately. The sooner you get help and support for the child, the better the child's chance of recovery.

If the child needs immediate medical attention, call 911 or your local emergency number. Depending on the situation, contact the child's doctor, a local child protective agency, the police department, or a hotline such as Childhelp National Child Abuse Hotline (800-422-4453).

Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county or state authorities.

Child abuse occurs across all social and economic levels and ethnic groups. Factors that may increase a person's risk of becoming abusive include:

A history of being abused or neglected as a child

Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)

Family crisis or stress, including domestic violence and other marital conflicts, single parenting, or young children in the family, especially several children under age 5

A child in the family who is developmentally or physically disabled

Financial stress or unemployment

Social or extended family isolation

Poor understanding of child development and parenting skills

Alcoholism or other forms of substance abuse

Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support who can adapt and cope with bad experiences. For many others, however, child abuse has lifelong consequences. For example, child abuse may result in physical, behavioral, emotional and mental issues. Examples include:

Physical issues

Death

Physical disabilities and health problems

Learning disabilities

Attention-deficit/hyperactivity disorder (ADHD)

Substance abuse

Behavioral issues

Delinquent or violent behavior

Abuse of others

Withdrawal

Suicide attempts

Frequent, casual sex with many different partners (sexual promiscuity) or teen pregnancy

Emotional issues

Low self-esteem

Difficulty establishing or maintaining relationships

Challenges with intimacy and trust

An unhealthy view of parenthood that may perpetuate the cycle of abuse

Inability to cope with stress and frustrations

Mental disorders

Eating disorders

Personality disorders

Depression

Anxiety

Post-traumatic stress disorder (PTSD)

Talk therapy, also called psychotherapy, can help a child who has been abused learn to trust again, as well as teach the child about normal behavior and relationships. Therapy can also teach children conflict management and boost self-esteem. Several different types of therapy may be effective, such as:

Trauma-focused cognitive behavioral therapy. This type of therapy helps an abused child to better manage distressing feelings and to deal with trauma-related memories. Eventually, the nonabusing parent and the child are seen together so the child can let the nonabusing parent know exactly what happened.

Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.

Psychotherapy can help parents discover the roots of abuse, learn effective ways to cope with life's inevitable frustrations and learn healthy parenting strategies. If the child is still in the home, social services may schedule home visits and make sure essential needs, such as food, are available.

Children who are placed in foster care because their home situation is too dangerous will also need mental health services and therapies.

Places to turn for help

If you need help because you're at risk of abusing a child or you think someone else has abused or neglected a child, there are organizations that can provide you with information and referrals, such as:

Childhelp National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)

Prevent Child Abuse America: 800-CHILDREN (800-244-5373)

If a child tells you he or she is being abused, take the situation seriously. The child's safety is most important. Here's what you can do:

Encourage the child to tell you what happened. Remain calm as you assure the child that it's OK to talk about the experience, even if someone has threatened him or her to keep silent. But don't ask leading questions (questions that suggest specific answers) — leave detailed questioning to the professionals.

Remind the child that he or she isn't responsible for the abuse. The responsibility for child abuse belongs to the abuser. Say "It's not your fault" over and over again.

Offer comfort. You might say, "I'm so sorry you were hurt," "I'm glad that you told me," and "I'll do everything I can to help you." Let the child know you're available to talk or simply listen at any time.

Report the abuse. Contact a local child protective agency or the police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.

Help the child remain safe. Don't let the child be alone with the abuser. If that's not possible, do what you can to eliminate the abuser's access to the child. Make sure the child knows how to call for emergency help if needed.

Consider additional support. You might help the child seek counseling or other mental health treatment. Age-appropriate support groups also can be helpful.

If the abuse has occurred at school, make sure the principal of the school is aware of the situation, in addition to reporting it to the local or state child protection agency.

You can take simple steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. For example:

Offer your child love and attention. Nurturing your child, listening and being involved in his or her life can develop trust and good communication. This encourages your child to tell you if there's a problem.

Don't respond in anger. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child. Talk with your doctor or therapist about ways you can learn to cope with stress and better interact with your child.

Think supervision. Don't leave young children home alone. In public, keep a close eye on your child. Volunteer at school and for activities so that you get to know the adults who spend time with your child. Don't allow your child to go anywhere or accept anything without your permission. When your child is old enough to leave home without parental supervision, encourage your child to stay away from strangers and to hang out with friends rather than alone — and to tell you where he or she is at all times. Make sure you know who is supervising your child when he or she is out of your care, such as at a sleepover.

Emphasize the importance of saying no. Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something does happen, encourage your child to talk to you or another trusted adult about the episode. Assure your child that it's OK to talk and that he or she won't get in trouble.

Teach your child how to stay safe online. Place the computer in a common area of your home. Use the parental controls to restrict the types of websites your child can visit, and check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities. Cover ground rules, such as not sharing personal information, not responding to inappropriate, hurtful or frightening messages, not sharing photos or videos online, and not arranging to meet an online contact in person without your permission. Tell your child to let you know if an unknown person makes contact through a social networking site. Report online harassment or inappropriate senders to your service provider and to local authorities, if necessary.

Reach out. Meet the families in your neighborhood, including both parents and children. Consider joining a parent support group so you have an appropriate place to vent your frustrations. If a friend or neighbor seems to be struggling, offer to baby-sit or help in another way.

If you worry that you might abuse your child

If you're concerned that you might abuse your child, seek help immediately, especially if you were abused as a child. If you were a victim of any type of child abuse, get counseling to assure you don't continue the abuse cycle or teach those destructive behaviors to your child. These organizations can provide information and referrals:

Childhelp National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)

Prevent Child Abuse America: 800-CHILDREN (800-244-5373)

Or you can start by talking with your family doctor. He or she may offer a referral to a parent education class, counseling or a support group for parents to help you learn appropriate ways to deal with your anger. If you're abusing alcohol or drugs, ask your doctor about treatment options. Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

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